Health Information Technology Policy and The States State Coverage Initiatives Meeting Albuquerque, New Mexico Ree Sailors NGA, Center for Best Practices July 31, 2009

The Economist, March 2006 National Governors Association

 Relevant state roles for HIT adoption  Regulate the insurance market  License and oversee health professionals and facilities  Purchase and fund health care services and coverage under Medicaid and other programs  Provide legal protections for consumers and others  Set the regulatory and legal environment on health record privacy and other relevant issues  Provide direct funding for public good  States are experienced in reform  They are practically focused  Experiences in interstate coordination  Very interested and actively engaged on health issues Why a State Alliance for e-Health?

 Voting Members- (13)  Governor Phil Bredesen, TN (Co-Chair)  Governor Jim Douglas, VT (Co-Chair)  2 Attorneys General  2 State Insurance Commissioners  4 State Legislators  2 Former Governors  1 State Health Official  Advisory members (7)  State health policymakers  Relevant private sector members  Technical experts Membership

Recommendations for Advancing e-Health in States Provide leadership and political support for e- health efforts Address privacy and security Promote the use of standards- based technology Streamline the licensure process to enable cross- state e-health Engage consumers to use HIT in managing their health Develop workforce and agency capacity

No Matter What – Ongoing Oversight & Assurances Ensuring the privacy and security of citizens’ electronic health information no matter what entity or entities operate the exchange, and Assuring providers, patients, and insurers that health information exchanges will operate in a sustainable, dependable, and efficient manner through fair and equitable charges placed on participants.

Roles for the States post HITECH Preparing or updating the state roadmap for HIE adoption; Engaging stakeholders; Establishing a state leadership office; Preparing state agencies to participate; Implementing privacy strategies and reforms; Determining the HIE business model; Creating a communications strategy; and Establishing opportunities for health IT training and education

Challenges Brokering of already deployed assets Moving from pockets to statewide and beyond Consensus vs. Direct Intervention Mergers and Acquisitions Standards for HIE Use for Quality Improvement – brokering the use of information

Preparing or Updating the Roadmap for HIE Adoption State Plans are specifically mentioned in HITECH Growing from pockets of activity to whole state and interstate Many states with plans previously were developed pre-HITECH First formal submissions to Federal government Governors accountable for ARRA spending

Engaging Stakeholders Role familiar to states Often only entity that can pull everyone together (anti-trust issues for some) Both convener and participant Stakeholders both within and outside of government Maintaining the “public good” in the mission

Establishing State Leadership Office Coordination within government Coordination with private sector Coordination with other HITECH & ARRA areas: broadband, Tribes, Community Health Centers, School- based Health Centers Endorsement and Oversight of State Designated Entities if applicable Integration with Larger Health Care Reform Efforts

Preparing State Agencies to Participate Medicaid Agency –Meaningful Use – one year transition –Eligibility for incentive payments and adoption reimbursements Public Health –Disease surveillance –Emergency Preparedness –Population Health Possible role in Loan Program

Implementing Privacy Strategies and Reforms Ensuring the privacy and security of citizens’ electronic health information no matter what entity or entities operate the exchange(s) Building public trust and confidence Tackling issues related to interstate transfers of health information Training for new State AG responsibilities related to enforcement of HIPAA provisions

Determining an HIE Operational & Business Model Seen one HIE seen one HIE Transitions and Modifications and Hybrids Government-led electronic health information exchange, Electronic HIE as a public utility with strong state oversight, and Private Sector-Led Electronic HIE with Government Collaboration & Oversight

Creating a Communications Strategy Consumers –Host town-hall meetings, webcasts, and other forums – seek input –Develop culturally and linguistically targeted materials –Tailor materials for special populations i.e., foster care, mental health, and special needs –Encourage and support the use of technologies— such as e-prescribing and PHRs—that build public experience in using EHRs. Providers –Privacy and security –How health IT and HIE will improve their practice and offer benefits

Opportunities for Health IT Training & Education Physicians, clinics, nurses, hospitals, and office managers must have guidance in reengineering workflow to ensure ongoing use and exchange Encourage educational institutions, particularly their community college system, and nonprofit groups to coordinate with the regional extension center program Ensure complete access to both rural and urban providers Incorporate training into statewide plans

Questions?